An outsourcing firm – whose work for GPs was described by a minister as ‘entirely unacceptable’ – and the UK arm of a private US healthcare insurer are to lead the development of an STP.
The Nottingham and Nottinghamshire STP (sustainability and transformation partnership) has awarded a £2.7m contract to Capita to help turn the STP into a more formal health body in charge of local budgets and healthcare – because it said it did not have the expertise in-house.
Last year, GPs criticised the ‘shambles’ which followed Capita being handed a £700m contract to provide back-up services for practices across England. There were shortages in basic equipment and delays in the transfer of medical notes.
In a Parliamentary debate Coventry North West Labour Party MP Geoffrey Robinson said the NHS had ‘ended up with a terrible service that is costing more than the previous service ever would’ because Capita was not ‘properly prepared … did not have a commitment to providing the service, and was unable to do so’.
Then minister for public health Nicola Blackwood described Capita’s performance as ‘entirely unacceptable’.
The deal is part of the STP’s development into an ACS (accountable care system) which would take control and responsibility of budgets and commissioning for the entire population of the area – as part of an England-wide drive to meet targets for vast budget cuts and meet pledges to improve local healthcare.
Capita has handed large parts of the contract, which runs during this financial year, to Centene UK, which is part of the major US healthcare insurer Centene Corporation – a firm with the strapline ‘better health outcomes at lower costs’. BMA News understands Capita will mainly be involved in the ‘assurance’ work necessary but Centene will be the ‘boots on the ground’ in developing the ACS.
Doctors leaders said the announcement was ‘extremely concerning’ and potentially validated concerns of health campaigners that the STP process could lead to greater privatisation of the NHS.
BMA East Midlands regional council chair Peter Holden said: ‘Capita’s reputation among doctors is frankly appalling – and it’s even more worrying that they are allowed to sub contract further and that’s compounded by the fact that the firm in question is involved in private healthcare.’
The Matlock GP added: ‘This seems, in some ways, to be a real kick in the teeth for the profession.’
The latest developments for the STP programme – which began last year and saw England carved into 44 areas for local leaders to drive care improvements and savings – was announced by NHS England chief executive Simon Stevens at the NHS Confed 17 event in Liverpool earlier this Summer.
Mr Stevens promised to end the ‘fractured’ health and social care system by empowering local leaders to drive improvements in their areas and said too many patients are ‘passed from pillar to post’.
He revealed that a number of areas of the country, covering seven million people, would be designated as ‘accountable care systems’, a new framework which would allow commissioners and providers to bypass tendering and competition rules.
The process in Nottingham was driven by NHS England who told areas across the country they needed to be partnered with organisations across the world who had experience of delivering major changes similar to the ACS process. Capita provided the link between health leaders in Nottingham and Centene, which had undertaken similar work in Spain, BMA News understands.
A Nottingham GP who wished to remain anonymous told BMA News that the decision had caused consternation locally. He said: ‘GPs are not very happy about Capita being involved in any way with STPs. Capita's track record with GP patient records, NHS pensions and GP Registrar payments has been shocking. It is unbelievable that Capita continue to get NHS contracts, despite ongoing failings.’
Nottingham’s ACS lead Stephen Shortt described the move as ‘a unique opportunity for Greater Nottingham to give people a more joined-up experience of healthcare, hospital care, mental health care and social care that better meets their needs locally and makes the very best use of available resources’.
Dr Shortt added: ‘We’ve identified ways that all of our organisations can begin to work as one system – with fewer barriers between services from the NHS, local councils and health providers – to ensure people are able to lead happy, healthy lives and to stay independent and well, and where possible receive care closer to home in the community.
‘The scale of transformation is unprecedented in England, but it has been achieved by health systems in other parts of the world such as Europe. That’s why we have to take this opportunity to learn from organisations with international experience of transformation, such as Centene’s work with Ribera Salud on the internationally renowned Alzira model in Valencia, Spain. Centene UK is not a healthcare provider but will advise us on the logistics of setting up a shared health and care system.’
There remain questions, however, on whether the new ACS structures would stand up robustly to legal challenge due to having no mention in the Health and Social Care Act 2012 or any other legislation – and the BMA has repeatedly called for Government and NHS leaders to ensure proper governance frameworks are in place before changing structures.
The areas currently progressing STPs into ACS’s are:
- Frimley Health including Slough, Surrey Heath and Aldershot
- South Yorkshire & Bassetlaw, covering Barnsley, Bassetlaw, Doncaster, Rotherham, and Sheffield
- Nottinghamshire, with an early focus on Greater Nottingham and Rushcliffe
- Blackpool & Fylde Coast with the potential to spread to other parts of the Lancashire and South Cumbria at a later stage
- Luton, with Milton Keynes and Bedfordshire
- Berkshire West, covering Reading, Newbury and Wokingham
Capita and Centene have been approached for comment.
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